Transcutaneous delivery of prostaglandin E1: in vitro and laser doppler flowmetry study.

The aim of this study was to assess the rate and extent of transcutaneous delivery of prostaglandin E1 (PGE1) from various formulations [liposomal, novel biphasic, and nonliposomal (oil/water cream) delivery systems] in vitro using diffusion cells and in vivo using laser doppler flowmetry, to aid in the development of a topically active preparation for the treatment of male sexual dysfunction. Percutaneous absorption through adult human foreskin was tested in flow-through diffusion cells using [3H]PGE1. Nine healthy volunteers participated in the crossover, randomized, double-blind, placebo-controlled study, where 0.1 g of each preparation was applied to a 4 cm2 area on the forearm. Laserflo BPM2 blood perfusion monitor with Model P-430 skin probe was used for evaluating skin blood perfusion. Encapsulation of PGE1 into novel biphasic delivery systems resulted in significantly increased skin blood perfusion relative to traditional liposomal, nonliposomal, and placebo formulations (6.25 +/- 1.58 vs 2.72 +/- 0.79, 0.53 +/- 0.64, and 0.58 +/- 0.06 mLLD/min/100 g, respectively, n = 9). The in vitro absorption of PGE1 through foreskin correlated well with the in vivo data (respective permeability coefficients 3.33, 1.57, and 1. 40 x 10(-4) cm/h). Formulation parameters greatly influence the absorption of PGE1 through skin as measured by laser doppler flowmetry, but by the application of a novel topical delivery technology, a significant enhancement of PGE1 delivery can be achieved.

Stiff wire manipulation of peritoneal dialysis catheters.

From January 1989 to June 1994 we examined the success rate of fluoroscopically guided stiff wire manipulation of malfunctioning peritoneal dialysis catheters (PDCs) at St. Paul's Hospital, Saskatoon. There were 341 (201 male, 140 female) patients with a PDC. There were 118 manipulations (70 initial, 48 remanipulations) for malposition, fibrin clot, or kinked catheter. Single-cuff Tenckhoff catheters accounted for 95% of manipulated PDCs. No complications including peritonitis, exit-site infections, ruptured catheter, or bowel perforation were reported postmanipulation. A successful manipulation was defined as a functional PDC at 30 days postmanipulation. There was an overall success rate of 64%-67% for initial manipulations (IM) and 48% for remanipulations (RM). Ninety percent of those PDCs requiring IM occurred within 42 days of surgical insertion. RM occurred on average 55 days after IM. There were no risk factors identified that predisposed patients for PDC manipulation. This success rate for combined IM and RM of PDCs is higher than those rates quoted in the literature (27%-42%). We conclude that fluoroscopically guided stiff wire manipulation of PDCs, including repeated attempts, is a safe and effective way of prolonging PDC life, thus avoiding the risks of repeated surgery, improving quality of life, and decreasing health care costs.